Patient-specific surgical devices, system, and methods

ABSTRACT

A surgical device includes a body having a first side with a first surface that is complementary to a surface of a foreign object disposed within a patient based on preoperative imaging of the patient. The body defines at least one hole positioned relative to the body to facilitate insertion of an elongate device at a predetermined location relative to the foreign object.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of pending U.S. patentapplication Ser. No. 16/531,469, filed Aug. 5, 2019 which is acontinuation of U.S. Pat. No. 10,413,308, issued Sep. 17, 2019, which isa is a National Stage Application, filed under 35 U.S.C. 371, ofInternational Patent Application No. PCT/US 2015/020414, filed on Mar.13, 2015, the entire contents of which are incorporated herein byreference.

FIELD OF DISCLOSURE

The disclosed systems and methods relate generally to surgical guidesand fixtures to locate cutting guides during orthopedic procedures.

BACKGROUND

Total joint replacement prostheses typically include a speciallydesigned jig or fixture to enable a surgeon to make accurate and precisebone resections in and around the joint being prepared to accept theprosthesis. The ultimate goal with any total joint prosthesis is toapproximate the function and structure of the natural, healthystructures that the prosthesis is replacing. Should the prosthesis notbe properly attached to the joint, i.e., an ankle, knee, shoulder,elbow, and hip, the misalignment could result in discomfort to thepatient, gait problems, or degradation of the prosthesis. Over a periodof time, the prosthesis may need to be replaced during what is known asa revision surgery.

Many surgical procedures, including revision procedures, employ the useof intra-operative fluoroscopy to check the alignment of theintramedullary cavities that are prepared to receive the jointreplacement prosthesis. However, the use of intra-operative fluoroscopyin the operating room has several drawbacks. One such drawback is thatthe use of fluoroscopy to check the alignment of intramedullary cavitiesformed during surgery increases the overall length of the surgicalprocedure as time is taken to acquire and evaluate the fluoroscopicimages. Long surgery times lead to increased tourniquet time for thepatient and therefore may increase recovery time.

Another drawback of fluoroscopy is exposing the patient and others inthe operating room to the ionizing radiation. For example, the U.S. Foodand Drug Administration (“FDA”) has issued several articles and publichealth advisories concerning the use of the fluoroscopy during surgicalprocedures. Consequently, even though steps are taken to protect thepatient and other from the ionizing radiation, it is virtuallyimpossible to eliminate all risk associated with the ionizing radiation.

SUMMARY

In some embodiments, a surgical device includes a body having a firstside having a first surface that is complementary to a surface of aforeign object disposed within a patient based on preoperative imagingof the patient. The body defines at least one hole positioned relativeto the body to facilitate insertion of an elongate device at apredetermined location relative to the foreign object.

In some embodiments, a system includes a surgical locator device and afirst guide. The surgical locator device including a body having a firstside and a second side. The first side of the surgical locator deviceincluding a first surface that is complementary to a surface of aforeign object disposed within a patient based on preoperative imagingof the patient. The body defines at least one hole positioned relativeto the body to facilitate insertion of a first elongate device at apredetermined location relative to the foreign object. The first cuttingguide defines at least one second hole sized and configured to receivethe first elongate device therein for locating the first guide relativeto the foreign object.

In some embodiments, a method includes establishing access to a joint ofa patient and placing a surgical locator device in contact with thejoint such that a first surface of the surgical locator device contactat least a portion of a foreign object disposed within the patient. Thefirst surface of the surgical locator device is complementary to theportion of the foreign object based on preoperative imaging of thepatient.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features and advantages of the disclosed systems andmethods will be more fully disclosed in, or rendered obvious by, thefollowing detailed description of the preferred embodiment of thedisclosed systems and methods, which are to be considered together withthe accompanying drawings wherein like numbers refer to like parts andfurther wherein:

FIG. 1 illustrates one example of a human ankle and foot.

FIG. 2 is a plan view of one example of a surgical locator device inaccordance with some embodiments.

FIG. 3 is a side view of the surgical locator device illustrated in FIG.2 in accordance with some embodiments.

FIG. 4 is a plan view of a patient-engaging side of the surgical locatordevice illustrated in FIG. 2 in accordance with some embodiments.

FIG. 5 illustrates one example of a surgical locator device engaging atibia, talus, and a foreign object positioned between the tibia andtalus in accordance with some embodiments.

FIG. 6 is another view of the surgical locator device engaging a tibia,talus, and a foreign object positioned between the tibia and talus inaccordance with some embodiments.

FIG. 7 illustrates one example of a cutting guide that can be positionedusing pins placed by a surgical locator device in accordance with someembodiments.

FIG. 8 illustrates the cutting guide illustrated in FIG. 7 positionedagainst a bone using pins placed by a surgical locator device inaccordance with some embodiments.

FIG. 9 illustrates one example of another cutting guide being positionedusing pins placed by a surgical locator device in accordance with someembodiments.

FIG. 10 illustrates another example of another cutting guide configuredto be positioned using pins placed by a surgical locator device inaccordance with some embodiments.

FIG. 11 illustrates one example of a resected bone space created usingcutting guides in accordance with some embodiments.

FIG. 12 is a flow diagram of one example of a method in accordance withsome embodiments.

DETAILED DESCRIPTION

This description of embodiments is intended to be read in connectionwith the accompanying drawings, which are to be considered part of theentire written description of the disclosed systems and methods. Thedrawing figures are not necessarily to scale and certain features of thesystems and methods may be shown exaggerated in scale or in somewhatschematic form in the interest of clarity and conciseness. In thedescription, relative terms such as “horizontal,” “vertical,” “up,”“down,” “top” and “bottom” as well as derivatives thereof (e.g.,“horizontally,” “downwardly,” “upwardly,” etc.) should be construed torefer to the orientation as then described or as shown in the drawingfigure under discussion. These relative terms are for convenience ofdescription and normally are not intended to require a particularorientation. Terms including “inwardly” versus “outwardly,”“longitudinal” versus “lateral” and the like are to be interpretedrelative to one another or relative to an axis of elongation, or an axisor center of rotation, as appropriate. Terms concerning attachments,coupling and the like, such as “connected” and “interconnected,” referto a relationship wherein structures are secured or attached to oneanother either directly or indirectly through intervening structures, aswell as both movable or rigid attachments or relationships, unlessexpressly described otherwise. When only a single machine isillustrated, the term “machine” shall also be taken to include anycollection of machines that individually or jointly execute a set (ormultiple sets) of instructions to perform any one or more of themethodologies discussed herein. The term “operatively connected” is suchan attachment, coupling or connection that allows the pertinentstructures to operate as intended by virtue of that relationship. In theclaims, means-plus-function clauses, if used, are intended to cover thestructures described, suggested, or rendered obvious by the writtendescription or drawings for performing the recited function, includingnot only structural equivalents but also equivalent structures.

The disclosed systems and methods utilize custom manufactured surgicalinstruments, guides, and fixtures that are based upon a patient'sanatomy as determined by a computer tomography scanner (CT), magneticresonance imaging machine (MRI), or other medical imaging technology.These disclosed systems are derived from image data acquired through themedical imaging as taught by the systems and methods disclosed in U.S.Pat. No. 5,768,134 issued to Swaelens et al., commonly assigned U.S.patent application Ser. No. 12/710,898, entitled “Patient SpecificSurgical Guide Locator and Mount,” and commonly assigned U.S. patentapplication Ser. No. 12/711,307, entitled “Method for Forming a PatientSpecific Surgical Guide Mount,” the entirety of which are allincorporated by reference herein.

The disclosed systems and methods build on these disclosed systems andmethods to provide the ability to perform surgical procedures beyond theinitial installation of an orthopedic prosthesis. In some embodiments,the disclosed systems and methods are used to perform revision surgeriesand/or fusion take-down surgeries. For example, the disclosed systemsand methods utilize the imaging of one or more foreign objects inpatient's body, such as a previously installed implant (including platesand screws, to list only a few possibilities), bone cement, bone graft,and/or other object not native to the patient's body, and createssurgical tools having a surface that conforms to and is complementary toa bone or cartilaginous surface and/or a surface of the one or moreforeign objects. These disclosed systems and methods advantageouslyimprove the accuracy of performing revision and other orthopedicprocedures.

FIG. 1 illustrates one example of a patient's ankle joint 10 comprisinga tibia 12, a talus 14, a calcaneus 16, and a fibula 18. The ankle joint10 illustrated in FIG. 1 also includes a foreign object 50 disposedbetween tibia 12 and talus 14. While foreign object 50 is illustrated asbone cement, foreign object 50 can take the form of bone graft or apreviously installed orthopedic implant. For example, in someembodiments, foreign object 50 includes one or more of a tibialcomponent, talar component, stem component, plate, screw, or othercomponent of an orthopedic prosthesis. Further, while the foreign object50 is described as being positioned within an ankle joint 10, one ofordinary skill in the art will understand that the foreign object can belocated in another joint including, but not limited to, a hip, knee,shoulder, elbow, and wrist, to identify only a few possible joints.

In some embodiments, ankle joint 10, or the joint of interest, includingforeign object 50 is imaged using a medical imaging technologyincluding, but not limited to, CT and MRI, to identify only a couple ofpossible technologies. The obtained image data is converted to a 3Dmodel of the ankle 10, including foreign object 50, in accordance withthe methods disclosed in, for example, U.S. Pat. No. 5,768,134 issued toSwaelens et al., commonly assigned U.S. patent application Ser. No.12/710,898, entitled “Patient Specific Surgical Guide Locator andMount,” and commonly assigned U.S. patent application Ser. No.12/711,307, entitled “Method for Forming a Patient Specific SurgicalGuide Mount,” all of which are incorporated by reference in theirentireties.

FIG. 2 illustrates one example of a surgical locator device 100 inaccordance with some embodiments. Locator device 100 includes amonolithic body 102 comprising a superior portion 104 and an inferiorportion 106. In some embodiments, portions 104 and 106 each respectivelyinclude approximately half of body 102 as divided about an approximatemidline. However, one of ordinary skill in the art will understand thatportions 104 and 106 can be otherwise divided such that inferior portionincludes more or less than half of body 102. Body 102 further includes afirst side 108 and a second side 110 disposed opposite first 108 as bestseen in FIG. 3. In some embodiments, first side 108 is apatient-engaging side and side 110 is configured to be engaged ormanipulated by a user.

In some embodiments, superior portion 104 includes a pair of arms 112,114 that extend away from a base 116 disposed between arms 112, 114 asbest seen in FIGS. 2 and 4. Base 116 includes an outwardly extending tab118 that defines holes 120, 122, 124 therethrough that extend in asuperior-inferior direction as best seen in FIG. 5. Hole 120 is disposedin a first plane, and holes 122, 124 are disposed in a second plane thatis spaced apart from the first plane in a posterior direction. Each ofholes 120, 122, 124 is sized and configured to receive a k-wire, pin, orother elongate radiopaque object therein for reasons described ingreater detail below. In some embodiments, holes 122, 124 are spacedapart from one another such that collectively holes 120, 122, 124 areconfigured to form a gunsight.

Referring now to FIGS. 2 and 4, body 102 defines several pairs of holesthat extending in an anterior-posterior direction. For example, in someembodiments, a first pair of holes 126 disposed adjacent to an inferioredge of body 102. The location of hole pair 126 relative to body 102 isdetermined based on preoperative imaging and planning such that holesare configured to guide the insertion of k-wires, pins, or otherelongate surgical instrument into talus 14 is at a specific locationthat corresponds to the location of holes 2104, 2106 of talar resectionguide base 2100 as disclosed in commonly assigned U.S. patentapplication Ser. No. 14/445,928, entitled “Ankle Replacement System andMethod,” the entirety of which is incorporated by reference herein, asdescribed in greater detail below. One of ordinary skill in the art willunderstand that the pair of holes 126 defined by body 102 can facilitatethe accurate placement of other cutting guides beyond a talar resectionguide base. Further, one of ordinary skill in the art will understandthat the number of holes may be varied such that fewer than two (e.g.,one) or more holes can be provided for guiding an elongate surgicaldevice (e.g., a pin) into a bone and/or foreign object that is then usedto guide another surgical instrument, such as a cutting guide, a drillguide, or a cannulated reamer, to list only a few possibilities.

Hole pair 128 is positioned superiorly relative to hole pair 126. Thelocation of hole pair 128 relative to body 102, in some embodiments,also is determined based on preoperative planning using imaging of thepatient such that k-wire(s), pin(s), or other elongate surgicalinstrument(s) is/are inserted at a location that facilitates theplacement of a surgical cutting device on the tibia 12. For example,holes 128 can facilitate the placement of a tibial cutting guide such ascut guide 290 disclosed in commonly assigned U.S. patent applicationSer. No. 14/445,928, entitled “Ankle Replacement System and Method.” Oneof ordinary skill in the art will understand that holes 126 defined bybody 102 can facilitate the accurate placement of other cutting guides,drill guides, or other surgical instruments. Body 102 defines anotherpair of holes 130, which are located along body 102 between holes 126and holes 128. Holes 130 are sized and configured to receive a k-wire,pin, or other elongate surgical device therein for securing surgicallocator device 100 to the joint 10.

In some embodiments, body 102 also defines an opening 132 between holes130 and holes 126 as illustrated in FIGS. 2 and 4. Opening 132 isdefined by walls 134, 136, 138, 140 and extends through body 102 (FIG.2). Advantageously, opening 132 provides a user of surgical locatordevice 100 with a viewing portal such that the user can view theunderlying joint structures when surgical locator device 100 ispositioned against the bone or cartilaginous structures of the joint 10.

The patient-engaging side 108 of locator device 100 includes one or morecontact surfaces that are designed to be complementary to theprominences and concavities of joint 10, including the surface featuresof tibia 12, talus 16, and foreign object 50. For example and as bestseen in FIG. 4, the superior portion 104 of patient-engaging side 108 ofbody 102 has a first surface topography 108 a that is complementary to adistal portion of tibia 12 and, in some embodiments, a second surfacetopography 108 b that is complementary to a portion of foreign object50. Inferior portion 106 of patient-engaging side 108 of body 102 has athird surface topography 108 c that is complementary to a portion of thetalar dome or proximal portion of talus and a portion of foreign object50.

The surgical locator devices and systems disclosed herein can be used ina wide variety of surgical methods, including revision surgeries andfusion takedowns to identify only a couple of non-limitingpossibilities. One example of a fusion takedown procedure is describednow with reference to FIGS. 5-12 in which FIG. 12 is a flow chart ofexample of a method 400 in accordance with some embodiments. One ofordinary skill in the art will understand that various surgicalprocedures can be performed using the locator devices disclosed hereinand therefore one or more steps of method 400 may be omitted andadditional steps also can be performed.

At block 402, the patient is imaged. For example, one or more areas of apatient can be imaged using one or more medical imaging technologiessuch as x-ray, CT, and/or MRI to list only a few possibilities. In someembodiments, a single joint of the patient is imaged. For example, whenthe fusion takedown is to be performed on a patient's ankle, one or moreimages of the patient's ankle can be acquired using medical imaginginstrumentation as will be understood by one of ordinary skill in theart.

However, in some embodiments, multiple joints of a patient are imaged inorder to gather data concerning the patient's anatomy. For example, inorder to be able to determine the anatomical and mechanical axes of thepatient's leg, the patient's ankle and at least one other joint, e.g.,knee or hip, also will be imaged.

At block 404, the image data is used to perform preoperative analysis ofthe surgical procedure. For example, the image data is used to generatethree-dimensional (3D) renderings of the patient's anatomy, which isthen used by a physician to assess the implant site and the develop asurgical plan as described in commonly assigned U.S. patent applicationSer. No. 12/711,307, which is incorporated by reference herein. Theacquired image data not only includes data concerning the patient'sanatomy, such as bones and/or cartilage, but the acquired image dataalso includes data concerning any foreign objects 50 within thepatient's body. The geometry and location of foreign objects 50 withinthe patient's body is used when developing the surgical plan andpreoperative analysis. In some embodiments, foreign object 50 is bonecement used to fuse the ankle joint 10 of the patient. However, one ofordinary skill in the art will understand that foreign object 50 can bean orthopedic implant.

At block 406, one or more patient-specific surgical devices, such as asurgical locator device 100, are fabricated. In some embodiments, asurgical locator device 100 is fabricated using stereolithography orselective laser sintering, to list only a couple of possible examples.The fabricated surgical locator device 100 will be sterilized andprepared for use during surgery as will be understood by one of ordinaryskill in the art.

At block 408, access to the joint is established, such as by making anincision to expose the bony and/or cartilaginous surfaces of the joint.In some embodiments, the incision is made along the anterior of thepatient's ankle joint 10 to expose at least the tibia 12, talus 14, andforeign object 50.

At block 410, with the joint 10 exposed, the patient-engaging side 108of surgical locator device 100 is placed in contact with a bony surface,a cartilaginous surface, and/or in contact with a surface of foreignobject 50. The position of patient-engaging side 108 relative to thesurface of joint 10 is adjusted by the surgeon until the surgicallocator device 100 “locks” to joint 10. As will be understood by one ofordinary skill in the art, the “locking” of surgical locator device 100to joint 10 is accomplished by aligning the complementary prominencesand concavities of the patient-engaging side 108 of surgical locatordevice 100 to the corresponding prominences and concavities of the tibia12, talus 14, and foreign object 50.

At block 412, the alignment of surgical locator device 100 relative totibia 12 is checked. For example, a radiopaque elongate orthopedicdevice 30 is inserted into hole 120 such that device 30 extendssuperiorly from base 116 and/or tab 118 of body 102 as shown in FIGS. 5and 6. In some embodiments, body 102 is pinned to joint 10 by insertinga k-wire or pin 32 into each of holes 130 to secure surgical locatordevice 100 to joint 10 during a fluoroscopic check. The fluoroscopiccheck is performed once the surgical locator device 100 is locked to thejoint 10 by imaging surgical locator device 100 to confirm the alignmentof orthopedic device 100 relative to tibia 12 and/or by checking thegunsight formed by the radiopaque objects disposed within holes 120,122, 124. The location of surgical alignment device 100 relative tojoint 10 can be adjusted intraoperatively by the surgeon depending onthe intraoperative fluoro checks. One of ordinary skill in the art willunderstand that checking the alignment of a surgical locator devicerelative to an anatomical structure of the patient or with respect toforeign object 50 does not always need to be performed.

At block 414, with the position of locator device 100 relative to joint10 confirmed, additional k-wires or pins 34, 36 are inserted into thetibia 12 and talus 14 through holes 126 and 128, respectively. Forexample, a pair of k-wires or pins 34 are inserted into talus 14 bybeing guided by holes 126 to position the k-wires or pins 34 at aspecific location in talus 14. Another pair of k-wires or pins 36 areinserted into tibia 12 by being guided by holes 128 at a specificlocation in tibia 12.

At block 416, the locator device 100 is removed from its engagement withjoint 10. For example, with k-wires or pins 36, 34 received within tibia12 and talus 14, the k-wires or pins 32 received in holes 130 areremoved and body 102 of locator device 100 is slid over the k-wires orpins 34, 36 received within holes 126 and 128 such that a pair ofk-wires or pins 36 remain positioned within tibia 12 and another pair ofk-wires or pins 34 remain positioned within talus 14.

In some embodiments, the locator device 100 is not removed from itsengagement with joint 10. For example, locator device 100 can beconfigured to include a pre-attached cutting or drill guide such thatthe pre-attached cutting or drill guide is positioned in the desiredlocation relative to an anatomical structure of the patient or withrespect to the foreign object 50 when locator device 10 is positioned.Additionally or alternatively, other surgical tools or devices can bepositioned relative to locator device 100 while locator device remainsin its engagement with joint 10.

At block 418, a first cutting guide is attached to one of the pairs ofk-wires or pins 34 and/or 36. In some embodiments a tibial cutting guideis positioned relative to tibia 12 by being guided by at least pins 36.For example, and as illustrated in FIG. 7, cutting guide is cuttingguide 250. In some embodiments, cutting guide 250 is positioned on tibia12 by introducing pins 36 into holes 252 defined by cutting guide 250and sliding cutting guide 250 along pins 36 until it contacts tibia 12as best seen in FIG. 8.

In some embodiments, the tibial cutting guide takes other forms andengage both pins 34 and 36. One example of such a cutting guide isillustrated in FIG. 9. As shown in FIG. 9, cutting guide 290 is placedrelative to tibia 12 and talus 14 by aligning pin holes 292 with pins 36and aligning pin holes 296 with pins 34. Body 294 of tibial cuttingguide 290 is slid along pins 34, 36 until cutting guide 290 contactstibia 12 and/or talus 14. One of ordinary skill in the art willunderstand that other cutting guides can be positioned relative to apatient's anatomy by being guided by pins 34 and/or 36 that have beenplaced using a surgical locator device having a patient-specific surfacethat is complementary not only to a patient's bony and/or cartilaginoussurface, but also to a surface of a foreign body 50 disposed within apatient.

At block 420, resections are made using the first cutting guide. Forexample, the cutting guide secured to a patient's bone via pins 34and/or 36 is used to guide a resecting tool, such as a bone saw. In theembodiment illustrated in FIGS. 7 and 8, a saw or other cutting guide isinserted into slot 256 and slots 258, which are defined by arms 254 ofcutting guide 250. In the embodiment illustrated in FIG. 9, a bone sawor other cutting device is inserted into slots 294 which guide cuttingdevice as bony cuts are made to the tibia 12. In some embodiments, thecutting guide can be configured such that cuts can be made to both thetibia 12 and talus 14.

In some embodiments the resections made using the first cutting guideincludes resecting at least a portion of foreign object 50. For example,foreign object 50 may be positioned within the patient such that when acutting device is guided by a cutting guide the cutting device makescontact with bone and a portion of foreign object 50.

At block 422, the first cutting guide and supporting pins are removedfrom the patient. For example, when the first cutting guide is supportedby pins 36 as illustrated in FIGS. 7 and 8, pins 36 are removed fromtheir engagement with the tibia 12 and cutting guide 250 also isremoved. Pins 34, which do not support a cutting guide in this example,are kept in their position.

Referring now to cutting guide 290 illustrated in FIG. 9, pins 36 areremoved from tibia 12, and pins 34 are removed from talus 14. Inaddition to removing pins and the cutting guides, resected bone and/orresected portions or fragments of foreign object 50 can also be removedfrom the surgical site as will be understood by one of ordinary skill inthe art.

At block 424, a second cutting guide, if applicable, is attached to apair of remaining k-wires or pins. For example, FIG. 10 illustrates oneexample of a talar cutting guide 300 in accordance with someembodiments. Talar cutting guide 300 defines an elongate slot 302 thatextends from a first hole 304 defined at a first end 306 to a secondhole 306 defined at a second end 308. Cutting guide 300 is positioned byinserting pins 34 extending from talus 14 in holes 304 defined bycutting guide 300 and sliding cutting guide along pins 34 until itcontacts talus 14.

At block 426, resections are made using the second cutting guide. Forexample, the cutting guide secured to a patient's bone via pins 34 isused to guide a resecting tool, such as a bone saw. In the embodimentillustrated in FIG. 10, a saw or other cutting guide is inserted intoslot 302 to resect talus 14. In some embodiments the resections madeusing the second cutting guide 300 includes resecting at least a portionof foreign object 50. For example, foreign object 50 may be positionedwithin the patient such that when a cutting device is guided by acutting guide the cutting device makes contact with bone and a portionof foreign object 50.

At block 428, the second cutting guide and supporting pins are removedfrom the patient, if applicable. For example, pins 34 can be withdrawnfrom talus 14, and the pins 34 and cutting guide 300 are removed fromtheir engagement with talus 14. As will be understood by one of ordinaryskill in the art, the resected bone and/or portion of foreign object 50also can be removed.

With the resections having been made to the bone and/or foreign object,a void is provided between the bones of the joint for furtherpreparation of the bones and/or foreign object to receive a prosthesis.For example, FIG. 11 illustrates one example of a resected bone space 80defined by resected surfaces 12A, 12B, 12C of tibia 12, resected surface14A of talus 14, and femur 18. As shown in FIG. 11, foreign object 50 isnot disposed within resected bone space 80 having been removed duringthe joint resections.

Further surgical steps can be performed to implant a joint prosthesis aswill be understood by one of ordinary skill in the art. Examples of suchprocedures are shown and described in commonly assigned U.S. Pat. No.8,808,297; U.S. Pat. No. 8,808,303; and U.S. patent application Ser. No.14/445,928, all of which are incorporated by reference herein in theirentireties. These surgical procedures are only a few examples ofpossible surgical techniques that can be performed using thepatient-specific tools described herein.

The disclosed systems and methods described above advantageously utilizemedical imaging to create custom surgical tools that include surfacesthat are not only complementary to a patient's bone and/or cartilaginoussurface, but also to any foreign objects within the patient. Thesesurgical tools improve the accuracy of performing revision surgeries aswell as orthopedic procedures such as fusion takedowns.

In some embodiments, a surgical device includes a body having a firstside having a first surface that is complementary to a surface of aforeign object disposed within a patient based on preoperative imagingof the patient. The body defines at least one first hole positionedrelative to the body to facilitate insertion of an elongate device at apredetermined location relative to the foreign object.

In some embodiments, the first side includes a second surface that iscomplementary to at least one of a first bone or a first cartilaginoussurface of the patient.

In some embodiments, the first side of the body includes a third surfacethat is complementary to at least one of a second bone or a secondcartilaginous surface of the patient.

In some embodiments, the at least one first bone is different from theat least one second bone.

In some embodiments, the at least one first bone and the at least onesecond bone together define at least a portion of a joint such that thebody is sized and configured to extend across at least the portion ofthe joint.

In some embodiments, the at least one hole includes a first pair ofholes, and the body defines a second pair of holes disposed at adistance from the first pair of holes. The second pair of holes ispositioned relative to the body to facilitate insertion of a second pairof elongate devices at a second predetermined location in at least oneof the second bone, the second cartilaginous surface, or the foreignobject.

In some embodiments, the first pair of holes are defined by a superiorportion of the body, and the second pair of holes are defined by aninferior portion of the body.

In some embodiments, the body defines an opening located between thefirst pair of holes and the second pair of holes.

In some embodiments, a second side of the body includes a tab outwardlyextending from a base. The tab defines a hole therein sized andconfigured to receive a radiopaque object therein.

In some embodiments, a system includes a surgical locator device and afirst guide. The surgical locator device including a body having a firstside and a second side. The first side of the surgical locator deviceincluding a first surface that is complementary to a surface of aforeign object disposed within a patient based on preoperative imagingof the patient. The body defines at least one first hole positionedrelative to the body to facilitate insertion of a first elongate deviceat a predetermined location relative to the foreign object. The firstguide defines at least one second hole sized and configured to receivethe first elongate device therein for locating the first guide relativeto the foreign object.

In some embodiments, the first side includes a second surface that iscomplementary to at least one of a first bone or a first cartilaginoussurface of the patient.

In some embodiments, the first side of the body of the surgical locatordevice includes a third surface that is complementary to at least one ofa second bone or a second cartilaginous surface of the patient.

In some embodiments, the at least one first bone and the at least onesecond bone together define at least a portion of a joint such that thebody of the surgical locator device is sized and configured to extendacross at least the portion of the joint.

In some embodiments, the at least one first hole includes a first partof holes, the at least one second hole includes a second pair of holes,and the body of the surgical locator device defines a third pair ofholes disposed at a distance from the first pair of holes. The thirdpair of holes is positioned relative to the body of the surgical locatordevice to facilitate insertion of a second pair of elongate devices at asecond predetermined location in at least one of the second bone, thesecond cartilaginous surface, or the foreign object.

In some embodiments, a second guide defines a fourth pair of holes thatare sized and configured to receive the second pair of elongate devicestherein for locating the second guide relative to at least one of thesecond bone, the second cartilaginous surface, or the foreign object.

In some embodiments, the first pair of holes is defined by a superiorportion of the body of the surgical locator device, and the third pairof holes are defined by an inferior portion of the body of the surgicallocator device.

In some embodiments, the body of the surgical locator device defines anopening located between the first pair of holes and the third pair ofholes.

In some embodiments, a second side of the body includes a tab outwardlyextending from a base. The tab defines a hole therein sized andconfigured to receive a radiopaque object therein.

In some embodiments, a method includes establishing access to a joint ofa patient and placing a surgical locator device in contact with thejoint such that a first surface of the surgical locator device contactsat least a portion of a foreign object disposed within the patient. Thefirst surface of the surgical locator device is complementary to theportion of the foreign object based on preoperative imaging of thepatient.

In some embodiments, a method includes inserting a first pin into afirst hole defined by the surgical locator device, removing the surgicallocator device from its engagement with the joint of the patient, andsliding a second surgical device along the first pin to locate thesecond surgical device relative to the joint of the patient.

In some embodiments, placing the surgical locator device in contact withthe joint includes placing a second surface of the surgical locatordevice in contact with at least one of a portion of a first bone or afirst cartilaginous surface and placing a third surface of the surgicallocator device in contact with at least one of a portion of a secondbone or a second cartilaginous surface of a second bone of the joint.The second surface of the surgical locator device being complementary tothe at least one of the portion of the first bone and the firstcartilaginous surface based on preoperative imaging of the patient. Thethird surface of the surgical locator device is complementary to atleast one of the portion of the second bone or the second cartilaginoussurface based on preoperative imaging of the patient.

In some embodiments, a method includes inserting a third pin into athird hole defined by the surgical locator device, inserting a fourthpin into a fourth hole defined by the surgical locator device, andsliding a third surgical device along the third and fourth pins tolocate the third surgical device relative to the joint of the patient.

It is to be understood that the disclosed systems and methods are by nomeans limited only to the particular constructions herein disclosed andshown in the drawings, but also comprises any modifications orequivalents within the scope of the claims.

What is claimed is:
 1. A system, comprising: a locator device having abody extending from an inferior portion to a superior portion and havinga first side and an opposed second side, the first side including afirst surface that is configured to conform to a foreign object disposedin a body of a patient based on preoperative imaging of the patient, theinferior portion of the body defining a first pair of holes, and thesuperior portion of the body defining a second pair of holes, whereinthe body is sized and configured to extend across a joint formed betweenat least two bones such that the first pair of holes is configured toguide a first pair of elongate devices into a first bone of the joint,and the second pair of holes is configured to guide a second pair ofelongate devices into a second bone of the joint; and a first guidedefining at least one hole sized and configured to receive athe firstelongate device therein for locating the first guide relative to theforeign object.
 2. The system of claim 1, wherein the body includes atab extending outwardly from the second side, the tab defining atab-hole that is perpendicularly aligned with at least one of the firstpair of holes and the second pair of holes.
 3. The system of claim 1,wherein the first side includes a second surface that is complementaryto at least one of a first bone and a first cartilaginous surface of thepatient.
 4. The system of claim 3, wherein the first side of the body ofthe surgical locator device includes a third surface that iscomplementary to at least one of a second bone or a second cartilaginoussurface of the patient.
 5. The system of claim 1, wherein the at leastone first bone and the at least one second bone together define at leasta portion of a joint such that the body of the surgical locator deviceis sized and configured to extend across at least the portion of thejoint.
 6. The system of claim 1, wherein the at least one first holeincludes a first pair of holes and the at least one second hole includesa second pair of holes, and the body of the surgical locator devicedefines a third pair of holes disposed at a distance from the first pairof holes, the third pair of holes positioned relative to the body of thesurgical locator device to facilitate insertion of a second pair ofelongate devices at a second predetermined location in at least one ofthe second bone, the second cartilaginous surface, or the foreignobject.
 7. The system of claim 6, further comprising a second guidedefining a fourth pair of holes that are sized and configured to receivethe second pair of elongate devices for locating the second guiderelative to at least one of the second bone, the second cartilaginoussurface, or the foreign object.
 8. The system of claim 6, wherein thefirst pair of holes is defined by a superior portion of the body of thesurgical locator device, and the third pair of holes are defined by aninferior portion of the body of the surgical locator device.
 9. Thesystem of claim 6, wherein the body of the surgical locator devicedefines an opening located between the first pair of holes and the thirdpair of holes.
 10. The system of claim 2, wherein the tab-hole is sizedand configured to receive a radiopaque object therein.
 11. A method,comprising: preoperatively imaging a joint of a patient's anatomy;establishing access to the joint of the patient; providing a surgicallocator device having a body extending from an inferior portion to asuperior portion and having a first side and an opposed second side, thefirst side including a first surface that is configured to conform to aforeign object disposed in a body of a patient based on preoperativeimaging of the patient, the inferior portion of the body defining afirst pair of holes, and the superior portion of the body defining asecond pair of holes, wherein the body is sized and configured to extendacross a joint formed between at least two bones such that the firstpair of holes is configured to guide a first pair of elongate devicesinto a first bone of the joint, and the second pair of holes isconfigured to guide a second pair of elongate devices into a second boneof the joint; placing the surgical locator device in contact with thejoint such that a first surface of the surgical locator device contactsat least a portion of the foreign object disposed within the patient,such that the first surface of the surgical locator device iscomplementary to the portion of the foreign object based on preoperativeimaging of the patient.
 12. The method of claim 11, further comprisinginserting a first pin into a first hole defined by the surgical locatordevice; removing the surgical locator device from its engagement withthe joint of the patient; and sliding a second surgical device along thefirst pin to locate the second surgical device relative to the joint ofthe patient.
 13. The method of claim 12, wherein placing the surgicallocator device in contact with the joint includes: placing a secondsurface of the surgical locator device in contact with at least one of aportion of a first bone or a first cartilaginous surface, the secondsurface of the surgical locator device being complementary to the atleast one of the portion of the first bone or the first cartilaginoussurface based on preoperative imaging of the patient; and placing athird surface of the surgical locator device in contact with at leastone of a portion of a second bone or a second cartilaginous surface of asecond bone of the joint, the third surface of the surgical locatordevice being complementary to at least one of the portion of the secondbone or the second cartilaginous surface based on preoperative imagingof the patient.